Healthcare Provider Details

I. General information

NPI: 1427122100
Provider Name (Legal Business Name): STEPHEN J MELSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: STEPHEN J MELSON MD

II. Dates (important events)

Enumeration Date: 11/17/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 BOREN AVE SUITE 1020
SEATTLE WA
98104-3508
US

IV. Provider business mailing address

901 BOREN AVE STE 1020
SEATTLE WA
98104-3595
US

V. Phone/Fax

Practice location:
  • Phone: 206-624-6454
  • Fax: 206-624-1489
Mailing address:
  • Phone: 206-624-6454
  • Fax: 206-624-1489

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberMD00014189
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: